Understanding the Difference Between “First Aid” and “Medical Treatment”

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On December 11, 2010, box maker Beverly Brown was walking down a vertical staircase at a Wayne Farms chicken processing plant in Decatur, Alabama, when she lost her balance and fell. Her only obvious injury was a cut on her lip, so Brown was taken to the plant’s medical room, where she was given an antibiotic ointment. While Brown was sitting in a chair in the medical room, she passed out. Her employer called 911, but it was too late: Brown was pronounced dead in the emergency room a short time later. Because she had been given an antibiotic ointment, Wayne Farms determined that the incident was a “first-aid event” and did not record it in their Log 300 or call OSHA.

Here are some situations you might encounter. Are they first aid or medical treatment?The Wayne Farms case is extreme, and probably a deliberate misread of OSHA’s injury and illness record-keeping standards (when a worker dies, it’s definitely recordable and reportable), but there are many cases in which employers have difficulty determining whether a worker received “first aid,” as defined by the standard, or recordable “medical treatment.”

Prophylactic Antibiotics: First Aid or Medical Treatment?

An employer wrote to OSHA asking about this scenario: An employee was bitten by a deer tick in the work environment. The employee missed no work time, showed no signs of illness, and did not contract Lyme disease or any other illness as a result of the bite. However, out of an abundance of caution, because of the area of the United States in which the employee was bitten, the doctor prescribed antibiotics as a preventive measure.

Was it first aid or medical treatment????

Answer: medical treatment.

OSHA has answered this question multiple times, actually, beginning in the preamble to the record-keeping standard, where the Agency stated that the use of prescription medications is not first aid because prescription medications are powerful substances that can be prescribed only by a licensed healthcare professional. The preventive, precautionary, or prophylactic nature of a medication is not controlling for determining OSHA recordability. The issuance of prescription antibiotics is considered medical treatment beyond first aid for OSHA injury and illness record-keeping purposes.

Just to keep you on your toes, though, the preamble also specifies that the administration of prescription medications used solely for diagnostic purposes (like eye drops) does qualify as first aid, while a recommendation from a physician to use a non-prescription medication at a prescription dose (for example, ibuprofen) is medical treatment.

Exercise Regimen: First Aid or Medical Treatment?

An employer wrote to OSHA asking whether an exercise regimen recommended and directed by a Certified Athletic Trainer should be classified as “first aid” or “medical treatment” for OSHA injury and illness record-keeping purposes.

What do you think? Is it first aid or medical treatment?

Answer: Medical treatment.

Therapeutic exercise is addressed in OSHA’s preamble to the final injury and illness record-keeping rule. OSHA stated that it considers therapeutic exercise a form of physical therapy, and deliberately left it out of the list of first-aid treatments in Section 1904.7(b)(5)(ii). Physical therapy is considered medical treatment.

Just to keep you on your toes, if a worker is given recommendations for an exercise regimen absent any symptoms of a work-related injury—for example, if the recommendation is given as part of a wellness program—there is no recordable injury involved, and the exercise regimen does not fall under the record-keeping standard’s requirements.

In October 2009, the General Accounting Office issued a scathing report criticizing OSHA for under-counting work-related injuries and illnesses. As a result of that report and other factors, OSHA has stepped up enforcement of its injury and illness record-keeping and reporting requirements. Because of this increased emphasis, employers need to take extra care in determining what is or is not a recordable injury or illness—which means, among other things, paying close attention to whether an injury receives medical treatment or just first aid. Do you know the difference?

An employer asked OSHA about heat therapy. Heat and cold therapy are actually included in the definition of first aid, but the employer wanted to know whether there were exceptions. Does it matter how often heat or cold is applied? Does it matter where it is applied? Does it matter what condition it is used to treat?

Heat or Cold Therapy: First Aid or Medical Treatment?

What do you think? Are there situations when heat or cold therapy would be medical treatment instead of first aid?

Answer: It’s first aid.

As mentioned, the definition of “first aid” found in Section 1904.7(b)(5)(ii)(e) specifically includes “hot or cold therapy.” In the preamble to OSHA’s 2001 final rule, OSHA stated that hot and cold treatment is first aid regardless of:

  • The number of times it is applied,
  • Where it is applied, and
  • The injury or illness to which it is applied.

Because hot and cold treatment is simple to apply, does not require special training, and is rarely used as the only treatment for any significant injury or illness, OSHA classifies all forms of heat or cold treatment as first aid, including compresses, soaking, and nonprescription skin creams/lotions for local relief.

Just to keep you on your toes, though, OSHA classifies both whirlpool treatments and ultrasound therapies as forms of physical therapy, so those are medical treatment for purposes of OSHA record-keeping.

Kinesiology Tape: First Aid or Medical Treatment?

Another employer wrote to OSHA to ask: Is kinesiology tape considered medical treatment for OSHA record-keeping purposes?

What do you think? Is it first aid or medical treatment?

Answer: It’s medical treatment.

In consultation with physicians in OSHA’s Office of Occupational Medicine, OSHA determined that kinesiology taping is designed to relieve pain through physical and neurological mechanisms. The lifting action of the tape is supposed to relieve pressure on pain receptors directly under the skin, allowing for relief from acute injuries. Because the use of kinesiology tape is similar to physical therapy in this way, it is considered medical treatment beyond first aid for OSHA record-keeping purposes.

“Medical treatment” means the management and care of a patient to combat a disease or disorder.

Medical aid is the treatment given by, or under the supervision of, a physician at a medical facility or in transit to such a facility.

For the purposes of Part 1904, medical treatment does not include:

-Visits to a physician or other licensed health care professional solely for observation or counseling

-The conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (for example, eye drops to dilate pupils)

– Administering Hepatitis B vaccine and rabies vaccine

-Using physical therapy and chiropractic treatment

– First aid.

“First Aid”

First aid is the emergency care given to the injured or suddenly ill person at the scene, using readily available materials.

The objectives of first aid are to:

* preserve life;

* prevent the injury or illness from becoming worse;

* promote recovery.

Good safety practices prevent accidents. Good first aid prevents accidents from becoming tragedies.

-Using a non-prescription medication at nonprescription strength

-Administering tetanus immunizations.

-Cleaning, flushing, or soaking a wound on the surface of the skin

– Using wound coverings such as bandages, gauze pads, butterfly bandages or Steri-StripsTM

-Using hot or cold therapy; Using any non-rigid means of support, such as elastic bandages, wraps, or non-rigid back belts, etc.

-Using temporary immobilization devices while transporting an accident victim

– Drilling of a fingernail or toenail to relieve pressure or draining fluid from a blister

-Using eye patches

-Removing foreign bodies from the eye using only irrigation or a cotton swab

-Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs, or other simple means

-Using finger guards

-Using massages

-Drinking fluids for relief of heat stress.

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